The Impact of COVID-19 on the Cardiopulmonary Transplant Journey

PURPOSE: The effect of the COVID 19 pandemic had the potential to have a major impact on patients during their journey through transplant assessment and heart or lung transplantation. Patients awaiting cardiopulmonary transplantation form a vulnerable group at increased risk because of their end stage cardiovascular or respiratory disease. We evaluated the impact of COVID pandemic on our transplant program. METHODS: We retrospectively reviewed our adult and paediatric heart and lung transplant activity from 2015. We assessed deaths on the active waiting list between Jan - 27(th) May for each yearly period and compared our transplant activity for each financial year up to April 2020 and our activity between Jan - 27(th) May 2020 (the first UK pandemic peak) comparing this to the same period over the last five years. This allowed us to directly compare the effect of COVID with previous years activity. RESULTS: A total of 19 heart patients died during Jan to 27(th) May 2020. Out of the total deaths 4 were from paediatric group, 11 were post-transplant and 5 on the active list. There were no cardiac deaths related to COVID 19. The total deaths during the same period were 19, 24, 20 and 32 in the years 2019, 2018, 2017 and 2016 respectively. A total of 41 lung patients died during Jan to 27(th) May 2020. Out of the total 11 were on the active list awaiting transplant and 19 were post-transplant deaths. Of these 2 were COVID deaths. The corresponding deaths during year 2019, 2018, 2017 and 2016 were 46, 51, 49 and 46 respectively. Transplant activity from Jan to 27(th) May in 2016-19 averaged 32 (16 hearts,16 lungs); activity during the same time period in 2020 was 4 lungs and 13 hearts, clearly affected by reduced activity due to COVID19. CONCLUSION: This audit does not suggest a significant rise in mortality due to the COVID 19 pandemic in vulnerable patients either pre or post-transplantation. Measures such as shielding were highly effective in this population. Transplant activity for the year was affected.